Second lawsuit by Appalachian Regional Healthcare against Medicaid Managed Care: This time we also hear from the other side!
The prolonged period of confusion following the state-wide implementation of Medicaid Managed care throughout Kentucky was bad enough, but not unexpected given its broad sweep and its short implementation period. (Some background is available by clicking on the Medicaid Tag at the bottom of this article.) After an initial flurry of hearings in Frankfort, not much was appearing in the media, and those of us not in medical billing offices, seeing patients, or for that matter beneficiaries of Medicaid might have hoped that things were sorting themselves out. Alas, the worst seems yet to come. For me, the most recent and indeed frightening public notice that things were not self-correcting was the lawsuit filed by Appalachian Regional Healthcare (ARH) against one of the three new managed care organizations (MCOs) and Kentucky’s Medicaid Cabinet.
In that suit against Kentucky Spirit, we learned that not all the MCOs were able to pull together the necessary state-wide networks, that at least one large healthcare provider organization with a corner on a regional market was able to thumb its nose at an MCO, that payments to hospitals were painfully slow and lower than desired, and that Kentucky Hospitals have been engaged in disputes (legal and otherwise) with the Cabinet for quite some time over the adequacy of payments. It is always true that a lawsuit only represents one side’s positions, but these conclusions seem rather self-evident. You can read the lawsuit for yourself as well as my initial analysis elsewhere in these pages. It was clear to me that something bad was going to happen.
Now other shoes are falling. Insider Louisville extended its breaking reporting to a second and not unexpected lawsuit by ARH against Coventry Health Care and included a copy of a letter from the Executive Vice President of Coventry to the President of ARH. That suit itself is not yet available to me, but it sounds like it was very similar to the one against Kentucky Spirit. We are told that “Coventry will mount a fierce defense that will be an enormous drain for ARH.” I guess this is how the big boys play, but in fairness, Coventry tells a very different and equally believable story than that told by ARH in its suit against Kentucky Spirit, and seems earnestly to want to make things right for the citizens of Kentucky. Continue reading “The Medicaid Dominoes are Falling.”